The distribution of antibiotic use and its association with antibiotic resistance
- Harvard TH Chan School of Public Health, United States
- University of Toronto, Canada
- Boston Children's Hospital, United States
Abstract
Antibiotic use is a primary driver of antibiotic resistance. However, antibiotic use can be distributed in different ways in a population, and the association between the distribution of use and antibiotic resistance has not been explored. Here we tested the hypothesis that repeated use of antibiotics has a stronger association with population-wide antibiotic resistance than broadly-distributed, low-intensity use. First, we characterized the distribution of outpatient antibiotic use across US states, finding that antibiotic use is uneven and that repeated use of antibiotics makes up a minority of antibiotic use. Second, we compared antibiotic use with resistance for 72 pathogen-antibiotic combinations across states. Finally, having partitioned total use into extensive and intensive margins, we found that intense use had a weaker association with resistance than extensive use. If the use-resistance relationship is causal, these results suggest that reducing total use and selection intensity will require reducing broadly-distributed, low-intensity use.
Data availability
State-level, aggregate antibiotic use and resistance data used in the main analyses are in Figure 3 - Source data 1 and 2. We do not own and cannot publish disaggregated MarketScan or Medicare data. MarketScan data are available by commercial license from Truven Health (marketscan.truvenhealth.com). Medicare data are available from ResDAC (www.resdac.org). ResDAC requires an application ensuring that requesting researchers comply with Common Rule, HIPAA, and CMS security and privacy requirements. Disaggregated ResistanceOpen data are restricted due to hospitals' privacy concerns. ResistanceOpen data are available by request from HealthMap (www.resistanceopen.org).
Article and author information
Author details
Funding
National Institute of General Medical Sciences (U54GM088558)
- Scott W Olesen
- Marc Lipsitch
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Copyright
© 2018, Olesen et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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The distribution of antibiotic use and its association with antibiotic resistance
eLife 7:e39435.
https://doi.org/10.7554/eLife.39435
Further reading
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- Epidemiology and Global Health
- Microbiology and Infectious Disease
We are writing to reply to the comment by Pouwels et al., 2019 about our recent study (Olesen et al., 2018) on antibiotic use and antibiotic resistance.
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- Epidemiology and Global Health
- Evolutionary Biology
Several coronaviruses infect humans, with three, including the SARS-CoV2, causing diseases. While coronaviruses are especially prone to induce pandemics, we know little about their evolutionary history, host-to-host transmissions, and biogeography. One of the difficulties lies in dating the origination of the family, a particularly challenging task for RNA viruses in general. Previous cophylogenetic tests of virus-host associations, including in the Coronaviridae family, have suggested a virus-host codiversification history stretching many millions of years. Here, we establish a framework for robustly testing scenarios of ancient origination and codiversification versus recent origination and diversification by host switches. Applied to coronaviruses and their mammalian hosts, our results support a scenario of recent origination of coronaviruses in bats and diversification by host switches, with preferential host switches within mammalian orders. Hotspots of coronavirus diversity, concentrated in East Asia and Europe, are consistent with this scenario of relatively recent origination and localized host switches. Spillovers from bats to other species are rare, but have the highest probability to be towards humans than to any other mammal species, implicating humans as the evolutionary intermediate host. The high host-switching rates within orders, as well as between humans, domesticated mammals, and non-flying wild mammals, indicates the potential for rapid additional spreading of coronaviruses across the world. Our results suggest that the evolutionary history of extant mammalian coronaviruses is recent, and that cases of long-term virus–host codiversification have been largely over-estimated.
